Improve access to services

18

3. Health education

Health care providers to counsel care givers on home care of sick children and also teach them to look for signs of serious illness in children so that they know when to take them to the health facility immediately. Health education to care givers to emphasise on prevention of home injuries in children especially drowning.

4. Train medical personnel

Pre service and in service training of doctors, nurses and medical assistants to include primary care of children, recognising signs of serious illness and resuscitation of children. More doctors, nurses and medical assistants to be trained in the neonatal resuscitation programme NRP and paediatric advanced life support PALS.

5. Improve facilities

Facilities and equipment to manage sick children especially appropriate resuscitation equipment to be available in all clinics and AE departments. Inpatient facilities and equipment for management of sick children especially intensive care to be improved. Facilities and equipment to diagnose and manage children with congenital malformations, deformations and chromosomal abnormalities to be developed further.

6. Improve documentation

All certification of deaths to be done by medical personnel. Doctors to be trained to document cause of death according to ICD-10 coding. Medical certification of cause of death to be standardised for the country. System for verbal autopsy for non hospital deaths to be developed.

7. Research

Research on conditions originating from the perinatal period and congenital malformations deformations and chromosomal abnormalities to be encouraged. This or similar study to be done every 5 years to monitor trends and progress and to identify areas for improvement and further research. 19

6. ETHICS AND REGULATORY CONSIDERATIONS

6.1 Independent Ethics Committee This was an observational research and its conduct was unlikely to impact on the safety and well being of human subjects involved. However the protocol was still subjected to review and approval by the Medical Research Ethics Committee MREC of the Ministry of Health MOH. 6.2 Patient Information and Consent We did not request a written informed consent from the study subjects because it was not possible to do so even from the next of kin due to logistic difficulties. Our justifications were as follows: 1. This was an observational research and involved no risk to the late subjects. 2. This did not adversely affect the rights and welfare of the late subjects or the subjects’ next of kin. No identifiable personal information on individuals would be captured and for publication purposes only aggregate results would be reported. 6.3 Patient Data Protection Deceased’s anonymity was maintained at all times as no identifiable personal information on individuals was captured. This was to respect the privacy and confidentiality rules in accordance with applicable regulatory requirements. All electronic data processed at the Clinical Research Centre of Hospital Kuala Lumpur CRC HKL were identified by patient number only, thereby ensuring that patient’s identity remained unknown to the CRC staff.